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DOI: 10.1055/s-0034-1376040
Therapeutic potential of and treatment with boceprevir/telaprevir-based triple-therapy in HIV/chronic hepatitis C coinfected patients in a real-world setting
Aims: To assess the therapeutic potential of telaprevir (TPV)/boceprevir (BOC)-based triple-therapy in a complete cohort of HIV/chronic hepatitis C-coinfected patients (HIV/HCV). Moreover, case series of four HIV/HCV-genotype (HCV-GT)1 patients with rapid virologic response (RVR), who received only 28 weeks of BOC-based triple-therapy (CHC-28W-BOC), and four HIV-positive patients with acute hepatitis C without complete early virologic response (cEVR) who received BOC as an add-on to dual-therapy (AHC-ADD-BOC) were reported.
Methods: RVR and cEVR were defined as target not detectable HCV-RNA at treatment week 4 and 12, respectively.
Results:
290/440 HIV-positive patients with positive HCV-serology had at least one visit during the past two years, 142/290 had target detectable HCV-RNA with 64% (82/142) carrying HCV-GT1. While 18 HIV/HCV-GT1 displayed contraindications, 45% (64/142) of HIV/HCV were eligible for triple-therapy. Insufficiently controlled HIV-infection despite combined antiretroviral therapy (cART) (HIV-RNA< 50copies/mL: 73% vs. 22%; p < 0.001) and liver cirrhosis (31% vs. 8%; p = 0.025) were overrepresented among patients with contraindications for triple-therapy. During the first two years of triple-therapy availability, it was initiated in 42% (27/64) of HIV/HCV-GT1 eligible for triple-therapy. Modification of cART or TPV dose adjustment would have been necessary in
61% and 84% of HIV/HCV-GT1 on cART eligible for triple-therapy using TPV and BOC, respectively. All CHC-28W-BOC and AHC-ADD-BOC patients achieved either a sustained virologic or on-treatment response.
Conclusions:
Drug-drug interactions with cART complicate management in the majority of patients. Low treatment uptake rates during the first two years of triple-therapy availability suggest that its benefit in HIV/HCV-coinfected patients might fall short of expectations. Prospective studies are necessary to validate our observations on CHC-28W-BOC and AHC-ADD-BOC. Preliminary results of the “Individualized Triple-therapy Using Boceprevir in HIV-positive Patients With Hepatitis C (HIVCOBOC-RGT)” study will be included in the poster.